Diseases of the chest and the principles of physical diagnosis . ypes are of pathological interestonly and during life are not to be distinguished one from the other withthe exception of dermoid cysts. ^ Fortschritte der Medicin, 1895, xiii. 2 Brit. Med. Jour., 1901, i, 1831. ^ Edinburgh Med. Jour., December, 1916. 548 DISEASES OF THE BRONCHI, LUNGS, PLEURA, AND DIAPHRAGM The and carcinomatous growths, on the other hand,present characteristics which render it possible to make a correct diag-nosis of the maUgnant nature of the tumor in many instances. A sarcomamay spring from the c
Diseases of the chest and the principles of physical diagnosis . ypes are of pathological interestonly and during life are not to be distinguished one from the other withthe exception of dermoid cysts. ^ Fortschritte der Medicin, 1895, xiii. 2 Brit. Med. Jour., 1901, i, 1831. ^ Edinburgh Med. Jour., December, 1916. 548 DISEASES OF THE BRONCHI, LUNGS, PLEURA, AND DIAPHRAGM The and carcinomatous growths, on the other hand,present characteristics which render it possible to make a correct diag-nosis of the maUgnant nature of the tumor in many instances. A sarcomamay spring from the connective tissue in the mediastinum, the peribron-chial or the mediastinal lymph nodes. Tumors in this situation areusually of the spindle-celled type or lympho-sarcoma, the latter beingthe more common. The tumor usually consists of a solid mass which byits extension exerts more and more pressure on the mediastinal may extend beyond the limits of the mediastinum and invade the lungssecondarilv. Tumors situated in the anterior mediastinum very often. Fig. .—Sarcomatosis of pleura. cause a bulging of the chest wall in the median line or to one side or theother of the sternum. The consistency of these tumors is moderately firm and they are of agray, yellowish-gray or reddish color. Rapidly growing tumors are aptto be quite soft and friable. A primary carcinoma is not common in the mediastinum. If weeliminate cases which should be classed as sarcomas, lympho-sarcomas,secondary carcinomas, pleural endotheliomas, and bronchial carcinomas,few cases remain (Christian). A mediastinal growth occurring in middleaged people and which tends to spread to surrounding structures as indi-cated by the symptoms, physical signs and roentgenograms, is probably acarcinoma. The final proof, however, must rest on the histologicalexamination. DISEASES OF THE LLNGS 549 Symptoms.—From the clinical standpoint the benign tumors can bedismissed from consideration. With one exception the
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